Provider Demographics
NPI:1417106386
Name:TROXELL, MICKEY KAY (CATC II, CEAC II)
Entity type:Individual
Prefix:MS
First Name:MICKEY
Middle Name:KAY
Last Name:TROXELL
Suffix:
Gender:F
Credentials:CATC II, CEAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 17TH ST
Mailing Address - Street 2:SUITE A-8
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4350
Mailing Address - Country:US
Mailing Address - Phone:714-620-4353
Mailing Address - Fax:949-646-8447
Practice Address - Street 1:711 W 17TH ST
Practice Address - Street 2:SUITE A8
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4350
Practice Address - Country:US
Practice Address - Phone:949-646-8486
Practice Address - Fax:949-646-8447
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970088101YA0400X
CAPCE4240251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251300000XAgenciesLocal Education Agency (LEA)